- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.15 / $1,021.22 / $5,320.00
| Facility | | $533.15 | $1,021.22 | $5,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,516.00 / $10,990.10 / $30,856.09
| Facility | | $4,516.00 | $10,990.10 | $30,856.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.12 / $833.74 / $961.78
| Facility | | $580.12 | $833.74 | $961.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.18 / $733.18 / $1,005.58
| Facility | | $733.18 | $733.18 | $1,005.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $72.81 / $72.81 / $72.81
| Facility | AS | $72.81 | $72.81 | $72.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,113.00
| Facility | | $842.00 | $4,539.00 | $10,113.00 |